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Digestive Endoscopy 11/2012; 24(6):479. · 1.19 Impact Factor
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ABSTRACT: We report a case of main pancreatic duct (MPD)-type intraductal papillary mucinous neoplasms of the pancreas (IPMNs), in whom
diagnostic imaging modalities showed abnormal findings after 4 episodes of acute pancreatitis. The patient was 51years old
at his first admission for acute pancreatitis. He experienced two more episodes of acute pancreatitis, though repeated computed
tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) showed no abnormality to explain the cause of the
pancreatitis. After 3½ years from his first episode of pancreatitis, CT and endoscopic ultrasonography revealed pancreatic
duct dilation of the pancreas head. Seven years after the first admission, a second ERCP and intraductal ultrasonography revealed
a partially dilated MPD with papillary tumors. He underwent pancreaticoduodenectomy, and the pathological diagnosis was intraductal
papillary mucinous adenoma with moderate atypia. This case suggests that acute pancreatitis can precede visualized IPMNs.
Therefore, acute recurrent pancreatitis with unknown etiology should be followed up for the possibility of IPMNs, in order
to detect neoplastic changes in the early stage to provide a better prognosis for the patient.
KeywordsIntraductal papillary mucinous neoplasms of the pancreas–Acute pancreatitis–Endoscopic retrograde cholangiopancreatography–Endoscopic ultrasonography
Clinical Journal of Gastroenterology 05/2012; 4(5):307-312.
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Digestive Endoscopy 05/2012; 24(3):195-6. · 1.19 Impact Factor
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Toshiaki Kunimura,
Tomoko Inagaki,
Masahiro Wada, Jun Ushio,
Kasumi Sato,
Tetsuji Enosawa,
Masanao Nakashima,
Hirotaka Kato,
Ryouji Hayashi,
Kouji Saitou,
Toshio Morohoshi
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ABSTRACT: Background: Cathepsin D (CD) is an aspartyl lysosomal protease, and the prognostic value of CD expression has been studied in a variety Background: Cathepsin D (CD) is an aspartyl lysosomal protease, and the prognostic value of CD expression has been studied in a variety
of tumors, however, its role in early adenocarcinomas remains unclear. of tumors, however, its role in early adenocarcinomas remains unclear.
Aim of the Study: We evaluated the expression of CD in a series of colorectal adenomas with severe dysplasia containing foci of early carcinoma Aim of the Study: We evaluated the expression of CD in a series of colorectal adenomas with severe dysplasia containing foci of early carcinoma
and compared the results to several histopathological and immunohistochemical features. and compared the results to several histopathological and immunohistochemical features.
Methods: Adenomas were obtained by endoscopic polypectomy from 33 patients. Twenty-four of the 33 adenomas contained well-differentiated Methods: Adenomas were obtained by endoscopic polypectomy from 33 patients. Twenty-four of the 33 adenomas contained well-differentiated
adenocarcinomas and nine adenomas contained moderately differentiated adenocarcinomas. adenocarcinomas and nine adenomas contained moderately differentiated adenocarcinomas.
Results: Positive CD expressions were observed in 25% of well-differentiated adenocarcinomas and in 66.7% of moderately differentiated Results: Positive CD expressions were observed in 25% of well-differentiated adenocarcinomas and in 66.7% of moderately differentiated
adenocarcinomas (p<0.05). Of the 12 adenocarcinomas with positive CD expression, four had positive CD expression in their adenomas (p<0.01), 6 showed positive Ki-67 expression in their adenomas (NS), and 10 had positive p53 expression in their adenomas (p<0.05). No significant association was seen between the level of CD expression and adenoma size. adenocarcinomas (p<0.05). Of the 12 adenocarcinomas with positive CD expression, four had positive CD expression in their adenomas (p<0.01), 6 showed positive Ki-67 expression in their adenomas (NS), and 10 had positive p53 expression in their adenomas (p<0.05). No significant association was seen between the level of CD expression and adenoma size.
Conclusions: The expression of CD in adenocarcinoma correlated significantly with differentiation, and with the levels of CD and p53 expression Conclusions: The expression of CD in adenocarcinoma correlated significantly with differentiation, and with the levels of CD and p53 expression
in the adenomas of the polyp. in the adenomas of the polyp.
International Journal of Gastrointestinal Cancer 04/2012; 33(2):149-154.
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ABSTRACT: The accurate diagnosis of extrahepatic bile duct carcinoma is difficult, even now. When ultrasonography (US) shows dilatation of the bile duct, magnetic resonance cholangiopancreatography followed by endoscopic US (EUS) is the next step. When US or EUS shows localized bile duct wall thickening, endoscopic retrograde cholangiopancreatography should be conducted with intraductal US (IDUS) and forceps biopsy. Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity. In patients with papillary type bile duct carcinoma, three biopsies are sufficient. In patients with nodular or infiltrating-type bile duct carcinoma, multiple biopsies are warranted, and IDUS can compensate for the limitations of biopsies. In preoperative staging, the combination of dynamic multi-detector low computed tomography (MDCT) and IDUS is useful for evaluating vascular invasion and cancer depth infiltration. However, assessment of lymph nodes metastases is difficult. In resectable cases, assessment of longitudinal cancer spread is important. The combination of IDUS and MDCT is useful for revealing submucosal cancer extension, which is common in hilar cholangiocarcinoma. To estimate the mucosal extension, which is common in extrahepatic bile duct carcinoma, the combination of IDUS and cholangioscopy is required. The utility of current peroral cholangioscopy is limited by the maneuverability of the "baby scope". A new baby scope (10 Fr), called "SpyGlass" has potential, if the image quality can be improved. Since extrahepatic bile duct carcinoma is common in the Far East, many researchers in Japan and Korea contributed these studies, especially, in the evaluation of longitudinal cancer extension.
World journal of clinical oncology. 05/2011; 2(5):203-16.
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Nippon rinsho. Japanese journal of clinical medicine 02/2006; 64 Suppl 1:203-6.
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Toshiaki Kunimura,
Tomoko Inagaki,
Masahiro Wada, Jun Ushio,
Kasumi Sato,
Tetsuji Enosawa,
Masanao Nakashima,
Hirotaka Kato,
Ryouji Hayashi,
Kouji Saitou,
Toshio Morohoshi
[show abstract]
[hide abstract]
ABSTRACT: Cathepsin D (CD) is an aspartyl lysosomal protease, and the prognostic value of CD expression has been studied in a variety of tumors, however, its role in early adenocarcinomas remains unclear.
We evaluated the expression of CD in a series of colorectal adenomas with severe dysplasia containing foci of early carcinoma and compared the results to several histopathological and immunohistochemical features.
Adenomas were obtained by endoscopic polypectomy from 33 patients. Twenty-four of the 33 adenomas contained well-differentiated adenocarcinomas and nine adenomas contained moderately differentiated adenocarcinomas.
Positive CD expressions were observed in 25% of well-differentiated adenocarcinomas and in 66.7% of moderately differentiated adenocarcinomas (p < 0.05). Of the 12 adenocarcinomas with positive CD expression, four had positive CD expression in their adenomas (p < 0.01), 6 showed positive Ki-67 expression in their adenomas (NS), and 10 had positive p53 expression in their adenomas (p < 0.05). No significant association was seen between the level of CD expression and adenoma size.
The expression of CD in adenocarcinoma correlated significantly with differentiation, and with the levels of CD and p53 expression in the adenomas of the polyp.
International Journal of Gastrointestinal Cancer 02/2003; 33(2-3):149-54.
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ABSTRACT: A 58-year-old man was diagnosed as having type 3 gastric cancer (poorly differentiated adenocarcinoma). He underwent total gastrectomy with splenectomy, as well as D3 dissection, and received postoperative chemotherapy combining oral uracil and futrafur (UFT) with cisplatin (CDDP), but results showed recurrence of multiple abdominal lymph node metastases around the aorta. He therefore received various anticancer drug regimens (irinotecan [CPT-11]/CDDP; 1 M tegafur-0.4 M gimeracil-1 M oteracil potassium [TS-1], methotrexate (MTX)/5-fluorouracil); however, final results showed growth of lymph node metastasis and simultaneous worsening of his general condition. The patient then received combined administration of doxifluridine (5'-DFUR)/docetaxel (5'-DFUR, 1000 mg/body [666.7 mg/m(2)], given by consecutive daily administration, orally, for days 1-14; and docetaxel, 80 mg/body [60 mg/m(2)], on day 8, by venous drip, every 3 weeks). Three courses of this regimen resulted in approximately 90% reduction of the abdominal lymph node size, disappearance of the right cervical lymph node metastasis, reductions of the levels of two tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA]19-9), and improvement of his general condition. In total, seven courses of the regimen were carried out. The patient died on day 298 after starting this combined regimen and showed a response period of 126 days. The primary toxicity identified was neutropenia (grade 4), as well as other low-grade (grade 1, 2) hematological and nonhematological toxicities. In the field of gastric cancer treatment, especially for patients showing multiple resistance to anticancer drugs, an effective therapy is critically needed.
Gastric Cancer 02/2002; 5(4):233-6. · 2.42 Impact Factor
